Non-Narcotic Analgesics (NSAID’s) 89teins and crosses placenta. The metabo-
lites of naproxen are almost entirely ex-
creted in urine. Naproxen is more effica-
cious and better tolerated. It is also longer
acting and has the advantage of twice
daily dosing.
Adverse effects include dyspepsia, gas-
tric discomfort, nausea, vomiting, heartburn,
dizziness, drowsiness, headache, fatigue,
sweating, depression, ototoxicity, pruritus
and thrombocytopenia.
It is indicated in osteoarthritis, rheuma-
toid arthritis, musculoskeletal disorders,
primary dysmenorrhoea, acute gout, pelvic
inflammation, ankylosing spondylitis, tooth
extraction, tendinitis, bursitis and juvenile
arthritis.
ANTHRANILIC ACID DERIVATIVESMEFENAMIC ACID
It is an inhibitor of cyclooxygenase with an-
algesic, antiinflammatory and antipyretic
properties.
It is readily absorbed from the GI tract,
extensively bound to plasma proteins and
excreted mainly in the urine as unchanged
drug or conjugated metabolites.
Adverse effects include drowsiness, di-
arrhoea, rashes (withdraw treatment),
thrombocytopenia, haemolytic anaemia,
aplastic anaemia. Convulsions may occur in
overdosage.
It is indicated in muscle, joint and soft
tissue pain, dysmenorrhoea, rheumatoid
and osteoarthritis, as antipyretic, in dental
pain, postoperative or postpartum pain.
OXICAM DERIVATIVESPIROXICAM
Piroxicam is a new NSAID and has anti-in-
flammatory, analgesic and antipyretic activ-
ity. It provides effective and long-lasting
relief of pain and stiffness. Its convenient
once daily dosage provides round the clock
relief of symptoms.
It acts peripherally by inhibiting the syn-
thesis of prostaglandins by reversible inhi-
bition of cyclooxygenase. Inhibition of the
migration of leukocytes to an inflammatory
site and inhibition of the release of lysoso-
mal enzymes may also be involved in the
antiinflammatory action.
It is well absorbed from the GIT. The rate,
but not the extent of absorption is decreased
by food and 99% plasma protein bound.
Piroxicam is metabolised in liver. Because of
long half life single daily administration is
sufficient. The half life may be especially pro-
longed in patients with renal function impair-
ment. Excretion of piroxicam is through re-
nal, fecal and as unmetabolised piroxicam.
Adverse effects include, nausea, vom-
iting, epigastric distress, skin rash, rarely
haematuria, proteinuria, hepatitis and de-
pression.
It is indicated in acute or long term use
in acute and chronic rheumatoid arthritis
and other rheumatic disorders like osteoar-
thritis, ankylosing spondylitis, cervical
spondylosis, acute gouty arthritis and acute
musculoskeletal disorders.
Tenoxicam is a congener of piroxicam
with similar properties and uses.